MEDICARE: DR. ANDREW CHARLES STUTZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3729	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3729	OTHER	NV	LICENSE NUMBER

General Provider Information

NPI Number	:	1053530089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CHARLES STUTZ D.D.S.

Provider Business Mailing Address
First Line	:	6425 BRISTLEBIRD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2231
Country	:	US
Telephone Number	:	702-451-3644
Fax Number	:	702-658-6435

Provider Business Practice Location Address
First Line	:	7035 W ANN RD
Second Line	:	SUITE # 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3863
Country	:	US
Telephone Number	:	702-396-2929
Fax Number	:	702-658-6435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ANDREW CHARLES STUTZ D.D.S.” Practice Location

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